Rachel Siewert (WA, Australian Greens) Share this | Link to this | Hansard source

On behalf of the Community Affairs References Committee, I present the report on the effectiveness of special arrangements for the supply of Pharmaceutical Benefits Scheme to remote area Aboriginal health services, together with documents presented to the committee.

Ordered that the report be printed.

by leave—I move:

That the Senate take note of the report.

This is a very important report because it pertains to the health of Aboriginal communities and to helping to close the gap. Many people are probably not aware of this scheme, which comes in two parts. It has special arrangements for the supply of PBS medicines to Aboriginal and Torres Strait Islander peoples in remote communities. This is obviously in place to promote and improve access to and use of PBS medicines. The two main programs we looked into are the section 100 supply program, which provides payments to community pharmacies for dispensing PBS medicines in bulk to remote area Aboriginal health services, and the section 100 pharmacies support allowance, which provides payments to community pharmacists to help Aboriginal health services to improve the way that their patients use PBS medicines.

These are very important programs, and I would particularly like to thank those who made very substantive submissions to this inquiry. In fact, they were so substantive that we did not have to hold a hearing, because such excellent information was supplied to us. I would like to thank the submitters and also the secretariat for the work they did. Many people will be aware of the workload that the Community Affairs Committee has had, both with legislation and references, this year, so I would like to thank the secretariat very much for their report.

We made a number recommendations in this report, and I hope that the government takes them on. One of the things the committee found is that other inquiries have made recommendations about these programs, but unfortunately those recommendations have not been implemented. I suggest that that is one of the reasons we have had to review this again and, in some cases, make some similar recommendations. We have made 10 recommendations, one of which related to the information we have showing that the effectiveness of the scheme, in terms of the amount of medication that is being supplied to remote communities, has gone up. We know the program, from that point of view, is successful in getting medicines out there. What we do not know is the clinical impact this has had. We are making an assumption that we are helping to close the gap by having this program in place, but we cannot really say that it is. So the committee made a recommendation that the government undertake an evaluation to ascertain whether the increased supply of PBS medicines provided by the program is having a clinical impact on the health of Aboriginal and Torres Strait Islander people in remote communities. I personally think that is a particularly important recommendation.

We have also made a recommendation about ensuring accurate and legible labelling on medicines. What we are finding is that some of these medicines are going out with handwritten labels, for example, and there is concern around that. So we have made a recommendation about ensuring that there is a universal system in place to provide for accurate and legible labelling and recording of medicines. The evidence given to us indicated that the Aboriginal health services needed more access to pharmacists in-house. Where we see pharmacists in-house in Aboriginal health services, we are seeing much better quality use of medicines. What we are trying to ensure here is quality use of medicines so we have good clinical outcomes. So there is a recommendation that various mechanisms be looked at in terms of enabling Aboriginal health services to have pharmacists in-house. There is also a recommendation about dose administration aids. At the moment, if they are funded under the scheme, they have to be funded out of the money for medications, and of course we want to see that money being used for medications. So we believe these aids need to be used. There was good evidence supplied to us that showed the effectiveness of using those particular aids.

There is also a recommendation around integrating some of the programs. There are a number of programs about increasing the supply of medications but also looking at the better quality use of medications. So we are recommending that there be a review, not to review the programs per se but to bring about better integration of some of those programs, because we established that there are some gaps in the supply of medications—for example, to aged-care facilities. It is unclear whether these people can access medications through this particular program.

I will conclude there because I know there are other senators who want to speak on this matter. I commend these recommendations to the government. I for one can tell the government and put them on notice that I will be pursuing the implementation of these recommendations, and I am sure no-one would expect any less.

Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

I also want to make some remarks on the recommendations and the process we followed in this Community Affairs References Committee inquiry. Certainly this is a much reviewed process. The remote area Aboriginal health services program, which includes the section 100 supply program and also the section 100 pharmacy support allowances, has been reviewed a number of times since it was introduced in 1999. There was a clear need identified in 1999. It was shown that Aboriginal and Torres Strait Islander people, particularly but not exclusively those in remote areas, were not receiving the benefit of our wonderful PBS system. At the time, 1999, the Centre for Remote Health noted that a review found that only 33c were spent on the PBS for Aboriginal and Torres Strait Islander people for each $1 spent on non-Indigenous people. This comparison made a benchmark about where we were moving in the process of allowing medication to be available for people who have great need. No-one denies the great need in remote Aboriginal and Islander communities and also in non-remote communities.

Through a number of submissions that came to the committee, we looked at the fact that since 1999 there have been extensive advances made in allowing medication to be available. The Department of Health and Ageing submission said, and I will put these figures on record, that from 1999 the remote area Aboriginal health service program:

… has grown from servicing 35 remote Aboriginal Health Services to 173 in 2011.

The supply of PBS items has increased from around 250,000 in 1999-2000 to more than 1.4 million in 2010-11.

In 2010-11, expenditure under the RAAHS Program had grown to $43 million from $3.9 million … in 1999.

Further, it is believed:

Around 170,000 Aboriginal and Torres Strait Islander people are estimated to benefit from the increased access to PBS medicines and better quality use of medicines …

So we do have that baseline data but, as Senator Siewert pointed out, we need to have more than just knowledge of how much medication is supplied. There is so much more that is needed. We need to look at the impact of the medication, and certainly one of the things we considered was: how do you actually see where people's chronic illness has been improved by this attention? We know it has. Intrinsically, we know that from 1999 until now, with the greater access to medication, of course people's health issues have been addressed, but we need to know that in greater detail.

We received very detailed information from people who wanted to do research in this area who said they had difficulty in getting the data. There is a good reason for that, but there is one issue that we should be able to respond to. What happens in areas of small populations is that the Privacy Act comes in and says that data cannot be released because of the possibility of individuals being able to be identified by the release of that data—a noble concern and one of which we should be aware. However, we need to be able to think smarter. There have got to be ways that the government and the stakeholders can work together effectively to see how we can understand exactly what this whole program is based on—that is, clinical health improvements for people who most need it.

Certainly one of our recommendations is that we work together. It seems a sensible enough recommendation that we get together all the people who have such great goodwill in this area who are trying to ensure that people in remote areas get access to the appropriate medication and then that their health is improved by that. As we often say here, we need to have ways of assessing that. That was one of the things that were picked up most clearly by our report.

I note that Senator Siewert also referred to one of the more interesting recommendations I have seen from any of our committee reports, which is in fact that we should go back and check all the recommendations that have been made in this area and see what is happening to them. I think that is common sense. It happens so often that people have issues which need to be considered, they evolve, more information becomes available, needs are identified and then we go into a quite in-depth inquiry to find out that this work has been done before. Recommendations have been made but somehow the recommendations have been lost and we have not been able to pick up on the knowledge and the professionalism that we know is available. So I really like that recommendation. Certainly our community affairs committee has worked very hard in the past to ensure that we have this process, that we consider issues and that after a certain period of time we go back and see what has happened. This is because in areas of social welfare we consistently have incremental improvements. So rather than going back and identifying all the issues again, we see what work has been done, the kind of recommendations that have been made by various governments and various groups of public servants working in the area and what has happened. It is almost a standing recommendation so that we can understand that we are working effectively to ensure that remote health issues are moving forward in our community.

Another one—and I know Senator Siewert mentioned it—was to do with the basic things that we take for granted in our own medical processes in terms of medical aids. The pure stupidity of the process means that people cannot get the basic help they need to learn about their medication and to use it more effectively through such things as the small pill advice thing that we have available all the time and which have proved to be deeply effective. That is not actually part of the process. It is extra expenditure and, as we know, expenditure is so tight that that kind of process is not provided. Straightforward processes about things that we all know and understand can be translated effectively to make the system work better.

I also take the note about the labelling process. Having worked with pharmacies over many years, I know the need to have a standard process of labelling and clarity so that people can understand their medication is so important and is something that once again at this time we need to restate.

A lot of good work has been done. We have seen that there have been advances, but there needs to be further consideration. Basic understanding of the whole process is not wide in the community. There has got to be more education in the way that professionals can work more effectively with communities so that people, again, understand their medication and are able to get the best use out of it. It is not just about spending the dollar; it is about how the dollar is spent and how effectively the community can benefit from it.

This is a necessary report. It is one that will stimulate further discussion. I note that the government will be considering it. I share with Senator Siewert a commitment to follow up so that the recommendations are discussed openly and we see some change not just in this place but more effectively in communities.

There is also the issue that we discuss so often in this place, and which the Community Affairs References Committee will be picking up in another inquiry, of rural and remote workforces. There is a great need to have more professional work done in communities and not just outside with people flying in and flying out. So I am looking forward to talking about that again in the future.

I commend the secretariat, who worked hard to prepare this particular report. We will be following up with all the people who have shown such great interest and goodwill in the process. I seek leave to continue my remarks later.

Leave granted; debate adjourned.